Surgeon prepares first voice-box transplant

By Roger Highfield

12:00AM GMT 29 Nov 2000

A SURGEON has been awarded £1.2 million to prepare for the first full voice-box transplantation.

Within a few years, Martin Birchall hopes to conduct a larynx transplant that will restore the ability of cancer patients to speak - they will keep their intonation and accent but will speak with the tonal qualities of the dead donor's voice box. The larynx is a gatekeeper that allows people to breathe, stops food from going down the wrong way, contains the vocal cords and seems to help to protect the body from infection and allergy.

Removal of the larynx, due to cancer, means more than losing the ability to speak: it plays a role in kissing, swallowing, laughing, crying, smell and taste, in sniffing, even lifting heavy weights, when vocal cords must close. A functioning replacement would bring a much higher quality of life to thousands of patients worldwide.

Mr Birchall, Reader in Head and Neck Surgery at the University of Bristol and Honorary Consultant at North Bristol NHS Trust said: "The removal of the larynx has profound effects. Some patients describe how they wake up after talking in their dreams and find themselves noiselessly crying."

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The leader of his field in Europe, he has been awarded a £1.2 million Fellowship by the charitable Wellcome Trust to make laryngeal transplantation routine for people who have had their voice boxes removed. Initial surgery will take place on people who have a paralysed voice box and the first transplants could follow within four years, he said yesterday.

One of the patients treated by the Bristol team, Dennis Anderson, a cabbie who had the operation after he contracted cancer, welcomed the new funds. When Mr Anderson, aged 64, lost his larynx, a hole was cut in his neck, near the adam's apple, to allow him to breath. To speak, he has to put his finger over the hole to push air into his mouth. To compensate for his lost vocal cords, he has a vibrating flap in a plastic valve in the windpipe. He has made an excellent vocal recovery and is now his taxi firm's radio controller.

Mr Birchall's transplant research will be conducted with immunologists Dr Mick Bailey and Prof Chris Stokes, Professor of Mucosal Immunology, at Bristol University's outpost in Langford. Like other transplants, laryngeal transplants require a donor organ from a body that matches the recipients blood and tissue types.

Mr Birchall hopes to reduce the use of anti-rejection drugs, which cause toxic side-effects. As well as exploring how rejection of the transplanted larynx can be reduced, Mr Birchall's group will collaborate with Dr Giorgio Terenghi, at the Royal Free Hospital, London, on ways to make damaged laryngeal nerves work normally.

The nerves were not connected to the larynx in the first human laryngeal transplant, performed in the United States in January 1998 on Timothy Heidler by Dr Marshall Strome of The Cleveland Clinic, Philadelphia. Before the operation, Mr Heidler communicated with the aid of an electro-larynx, a hand-held device that produces an electronic "voice".

The day after, Mr Heidler said his first real "hello" since he had injured his own larynx 19 years earlier in a motorcycle accident. The tonal quality of his voice was similar to the donor, which some relatives found disturbing.

Mr Birchall said: "The first transplant has been a qualified success. But he is still forced to breathe through a hole in the neck because they did not know how to repair the nerves controlling movement."